Health system structure and transformations in Colombia between 1990 and 2013: a socio-historical study

In 1993, Law 100 introduced major reforms to Colombia's health system and regulated the health care industry. We analyzed the structure of the social space of Colombia's health system and the transformations that took place between 1993 and 2013. We conducted a socio-historical study using a theoretical framework based on concepts developed by Pierre Bourdieu. In addition to documentary analysis, interviews were conducted with 26 key agents. We found that private health insurance companies situated at the 'dominant' pole accumulated capital and power during the period under study, while public and private providers situated at the 'dominated' pole face serious economic challenges due to the loss of capital and power. Measures taken by the state, a major funder of the system, to regulate the market have proved to be ineffective, forcing intervention from the legal field. More than two decades after Law 100 was introduced, health remains on the political agenda and the subject of dispute. A permanent crisis in the sector prevails partly due to the contradiction that exists between protecting the right to health, and strengthening of a profit-orientated market, thus hindering the fulfillment of the principles of quality and equity.